Injuries and Accidents

They're Easy to Avoid

The ice pack is doing its job. The pain has receded, the swelling is down, and your knee--except for an interesting configuration of cuts and colors--looks the way it's supposed to.

But it's going to be a few days before you're up and around. And right now, confined to a chair, feeling stiff and sore, you know that the next time you take a shortcut from one trail to another, you won't scramble across an outcropping of rock as though you were related to a mountain goat.

Nothing is more likely to make you feel like your body is 110 years old than an injury that lands you on your back or confines you to a chair. But whether the injury is caused by a car accident, a fall or a tricky move in a game of volleyball, just about everyone is at risk for an injury at one time or another.

According to the National Safety Council, injuries kill approximately 83,000 Americans every year, primarily through traffic accidents or falls. Despite what you might think, the risk isn't reserved for the elderly. In fact, more than half of all accidental deaths occur among men and women who are between the ages of 25 and 44.

But most of us won't die from injuries or accidents; we'll be temporarily sidelined. And for people between the ages of 25 and 44, the usual cause is a strained or torn muscle from a sports injury.

The Sports Connection

Sports injuries result in 6,000 deaths a year. Nonfatal injuries in recreational activities such as baseball and softball, basketball, football and bicycling put more than two million people in the emergency room every year. Add to that the mammoth numbers of strains and sprains that are treated in locker rooms, plus injuries suffered in dozens of other sports, and you can understand why the National Safety Council estimates that the total number of sports injuries exceeds three million each year.

People between the ages of 25 and 64 account for more than 74 percent of all emergency room visits for scuba-diving injuries, 68 percent for squash, racquetball and paddleball injuries, 51 percent for horseback-riding injuries, 45 percent for fishing injuries, 44 percent for tennis injuries, 42 percent for volleyball injuries and 40 percent for weight-lifting injuries.

Why are so many people in this age group getting hurt? "By age 25, people have become 'weekend athletes,' " explains Stephen J. Nicholas, M.D., associate team physician for the New York Jets and associate director of the Nicholas Institute of Sports Medicine and Athletic Injuries at Lenox Hill Hospital in New York City. "They're getting more involved with work, and social demands begin to take precedence over physical well-being.

"It's like putting your body in a cast and taking it out only on weekends," says Dr. Nicholas. "The muscles get short, weak and stiff. And they're no longer able to function at their optimal levels."

Studies show that women are most likely to experience ankle injuries, says Christine Wells, Ph.D., a member of the National Collegiate Athletic Association's Committee on Competitive Safeguards and Medical Aspects of Sport and professor of exercise science and physical education at Arizona State University in Tempe. The shoulder and knee also are frequently injured by women--the shoulder primarily from volleyball spikes and pitching, and the knee from a variety of stretches and twists.

Since men and women are equally likely to taper off their sports activities after age 25, both are liable to have bodies that are not quite up to extreme athletics on weekends.

Unfortunately, they still might think they're in peak condition, says Dr. Nicholas. So when they play sports such as tennis on the weekend, they push their bodies the way they used to when they were playing several times a week.

The result? The muscles fatigue, cramp, strain, then pull to the point where they can actually tear, says Dr. Nicholas.

How to Reduce Your Risk

It's difficult to rein yourself in when you're going for that extra mile or point, Dr. Nicholas adds. But here's how you can help your body keep up--and reduce your risk of injury.

Take a high school exam. If you're over age 25 and participating in weekend sports, schedule a physical exam with a family physician who does the local high school's team physicals, suggests Rosemary Agostini, M.D., a staff physician at the Virginia Mason Sports Clinic and clinical associate professor at the University of Washington, both in Seattle.

Ask her to give you the same type of physical that she gives the local football or basketball team, including a review of any previous sports injuries. Combined with a "weekend warrior" approach to sports, old injuries have a way of coming back to haunt you--sometimes on a chronic basis, says Dr. Agostini. A physician can evaluate the likelihood of that happening and make specific suggestions to avoid reinjury.

Balance your diet. "Some women athletes get so into exercise that they don't eat appropriately," says Dr. Agostini. "They don't end up with eating disorders, but they do have disordered eating patterns," in which they'll eat only pasta and vegetables one week or only fruits another.

But you can't build muscle or improve performance without eating a balanced diet, explains Dr. Agostini. A lack of calcium to build strong bones, a lack of iron to build red blood cells or a lack of protein to build and maintain muscle can not only sabotage your performance but set you up for injury as well.

Ask the doctor who does your physical to recommend a local sports nutritionist. Then work with her to develop an eating program that suits your particular needs.

Watch your periods. Some women will cease to menstruate when they reach certain exercise levels, says Dr. Agostini. The level is different for everyone, but it signals a hormonal imbalance that should be evaluated and corrected. If it's not, says Dr. Agostini, you're at increased risk for stress fractures or premature osteoporosis. So see your doctor if your periods stop for more than three cycles.

Turn in your shoes every 500 miles. Shoes need to provide good support and shock absorption to prevent injuries, says Dr. Agostini. Replace them every six months or 500 miles, whichever comes first. And remember that your foot size will probably be larger after pregnancy. So treat yourself to a new pair of shoes once the baby is born.

Keep moving. "You'll be able to minimize injuries if you go on a regular exercise program--one that involves 30 or 40 minutes every day or at least three or four times a week," says Dr. Nicholas. The point is that your body not be allowed five or six days in a row in which to stiffen up.

Stretch. Begin your exercise program with at least 25 minutes of stretching every time you work out, Dr. Nicholas says. The muscles in the back and front of your thighs--the hamstrings and quadriceps--plus those in the lower back are the most important to loosen up.

"They usually don't get any stretching during the day unless you specifically set out to do it," says Dr. Nicholas. "Yet one of the most common causes of lower back pain is a hamstring tightness that causes a pelvic tilt.

"If you can maintain your hamstrings in a loosened fashion," he adds, "you might minimize not only the number of hamstring pulls or lower extremity injuries you get but also the amount of lower back pain you develop in the future."

Make your body work. After you stretch, do any aerobic exercise--walking, running, jumping--that accelerates your heart rate and keeps you breathing hard--hard, not panting--for 20 minutes, says Dr. Nicholas.

The only exception is during the last trimester of pregnancy, he adds, when "the body releases a hormone called relaxin, which relaxes the body's soft tissue structures to prepare for childbirth." Unfortunately, it also loosens up all the ligaments holding your joints together.

Carrying on your regular aerobic exercise is fine as long as you have been cleared to exercise by your physician, says Dr. Nicholas. But you don't want to try for some new personal best during this period, because the increased stress on your relaxin-loosened joints makes you vulnerable to injury.

Lift. Strengthen your muscles by lifting at least a minimal amount of weight, says Dr. Nicholas. Get an athletic trainer to review your doctor's exam and recommendations and then to prescribe the specific weights and number of repetitions you should do. And don't forget to stretch before your workout.

Women in the last trimester of pregnancy should avoid weights altogether. Relaxin plus the joint stress from weights could predispose them to injury.

Activate your relationships. "I was talking to a friend of mine the other day, and we admitted that as we get older, there's always something that gets in the way of exercise," says Dr. Nicholas. "You have to meet someone for a drink, or you're trying to deal with a mortgage, a patient or the kids."

But if you arrange to meet friends for a game of tennis instead of a drink or you take your kids to the ice rink instead of a movie, he says, you're much more likely to get the extra exercise you need to stay loose and injury-free.

When You Make a Mistake

No matter how carefully you keep your body in shape, every once in a while you're going to pull or strain something when you twist the wrong way, intensify your exercise program or simply fall over your own two feet.

So here's what Dr. Nicholas advises you to do about a pulled or strained ligament, tendon or muscle.

Apply RICE. RICE may be the sports world's most important acronym. It means rest, ice, compression and elevation. And that's exactly what you should do for any new injury, says Dr. Nicholas. The idea is to minimize the amount of inflammation that occurs. It's inflammation that produces the swelling that causes the pain, which can then limit your movement.

"Put ice on the injury for three or four days," Dr. Nicholas says. "Apply it for 20 minutes of every hour you're awake." Wrap an elastic bandage around the injured area afterward, then elevate the injured muscle.

Take ibuprofen. "I also tell people to take Advil if they don't have any stomach problems," says Dr. Nicholas. That also reduces inflammation. Just follow package directions.

Use wet heat. Once you have RICE'd yourself for three or four days, it's time to work on getting your normal function back and preventing the injured area from becoming a chronic problem, says Dr. Nicholas.

The difficulty is that after three or four days, dried blood from torn or traumatized muscle fibers is sitting at the injured site.

"We need to get it out of the area," says Dr. Nicholas. "So we start what we call the wet heat program. We wrap a warm, wet towel around the injured area, put plastic--the kind of plastic bag you get at the dry cleaner's--around the towel to provide insulation, then put a heating pad on top.

"We leave it that way for about an hour and a half, three times a day, being careful not to burn the skin," he adds. "It will liquefy the dried blood in the injured area, bring the blood to the surface and help the body absorb it.

"It also helps with the healing process by loosening up the muscles."

Restretch the injured muscle. Once a muscle has been injured, both it and the surrounding muscles have contracted into shorter lengths, says Dr. Nicholas. So before you can resume your normal workouts, you have to restretch the muscles until they achieve their normal resting lengths. Ask an athletic trainer which stretches she suggests for your particular injury.

"If you don't achieve that resting length, you're more subject to chronic pulls that can occur again and again," says Dr. Nicholas.

Falling Down on the Job

Sports injuries may be costly in terms of time, pain and aggravation, but falls are more likely to kill. And not just older people. Nearly 1,100 men and women between the ages of 25 and 44 fell to their deaths in one year.

While falls that occur in the home are most likely to involve older folks with failing eyesight or wearing floppy footwear, falls by men and women between the ages of 25 and 44 are more likely to occur on the job, says researcher John Britt, R.N., state injury prevention program coordinator at Harborview Hospital in Seattle.

People fall when they're moving from one height to another on everything from stairs and stages to ladders and girders, according to safety experts at the Occupational Safety and Health Administration (OSHA) in Washington, D.C. Railings may stop unexpectedly before the last step, movable sets may not be clamped into place on stages, safety ropes may be torn or frayed on ladders, tools may inadvertently be left on girders.

Want to make sure you're not the next one to go bottoms up at work? Here's how Britt says you can reduce your risk.

Find the fall guy. Every company has someone whose job it is to make detailed reports of accidents to insurance companies, safety committees and workers' compensation, says Britt. Find that person. Then ask when and where every injury took place during the past 12 months. Then make sure you don't fall into the same traps that others did.

Make the invisible visible. People tend to pay attention to the little things and ignore huge ones, says OSHA. They see the tiny X-Acto blade that might slice their fingers in the art room but not the pool of ink on the floor that can cause them to slip.

Walk into any room at your workplace, stand in a corner, and look for anything that can trip you up or hurt you in any other way. Then either report the hazard to management or take care of it yourself.

Leave the high heels at home. If your company suggests you wear flats, nonskid soles, boots or other special footwear designed to keep you from falling down on the job, do it.

Be a Road Scholar

Many of the men and women who survive the ten million or so traffic accidents in the United States each year can no longer expect friends and co-workers to automatically extend their sympathies.

Instead, says Britt, their accident recitals are just as likely to be met with the question "Were you wearing your seat belt?" or "Did you stop by the bar before you drove home?"

"There's been a subtle shift in public opinion about motor vehicle accidents in the past couple of years," Britt explains. People used to feel sorry for accident victims. But today--partly due to national safety programs and citizen groups such as Mothers Against Drunk Driving--there's more of a sense that accidents are preventable.

What can you do? Here are three safety strategies that Britt feels will help you prevent--or survive--motor vehicle accidents.

Banish booze. Safety studies indicate that between 40 and 50 percent of all fatal accidents involve drunk drivers, says Britt. Alcohol is most likely to be involved in fatal crashes with adult male drivers between the ages of 20 and 55. And the more violent the crash, the more likely a drunk was at the wheel. So don't drink before you drive.

Stay alert on Fridays and Saturdays. One-third of all fatal crashes occur between 6:00 p.m. and 6:00 a.m. on Fridays and Saturdays, researchers report. So stay particularly alert during those times.

Use lap/shoulder belts. Many people simply won't wear safety belts in the mistaken belief that they have less chance of injury if they're "free" to get out of the car quickly. Unfortunately, these are the people who are least likely to get out of their vehicles at all. A study by the National Highway Traffic Safety Administration indicates that when they're worn carefully, lap/shoulder belts reduce the odds of occupant death in a crash by 45 percent.